If there is one thing that we know well, it is that an infertility diagnosis can be shocking and extremely overwhelming to most people. Many ask themselves, why me? what now? We want you to know that you are not alone, and we are here to walk you through this new world of infertility that you’re about to explore all while keeping it realistic.
Summarizing Infertility While Keeping It Human
STEP 1: Relax in the Facts
The good news is, if you want to achieve pregnancy and start a family, the odds are greatly in your favor that you will achieve your goal. So before taking one step forward, take a deep sigh of relief in that fact. When you start to feel tense, fall back on that thought as a soft place to land at the end of the day. We all need and deserve that.
STEP 2: Take control and research
Control is in your grasp. Seize the opportunity of that control. Keeping a sense of control over your choices is important to feeling at peace. While letting fate or time or someone else set your destination takes pressure off your back, doing so relinquishes your control and contributes to stress. It is like getting into a rideshare and telling the driver to take you wherever he is already going, and then getting mad that you did not end up where you wanted to go. Instead, allow yourself to take risk in admitting that you want a baby. Admitting it takes guts because there is a small risk of failure. Let’s say your goal is having a baby, set your “destination” to that goal, and research the different routes to get there, each with its own time estimate to reach the destination, like any map app on your phone.
Options for infertility treatment will include:
- Do nothing
Doing nothing is always an option. Keep in mind some general numbers. In fully fertile couples, the odds of getting pregnant in one month are not 100%, even if eggs, sperm, tubes, and uterus are normal. In fully fertile couples, pregnancy rates are estimated to be ~ 15% when female age is under 35, ~ 9 % per month with female age 35-39, and under 1% with female age 40+. Yes, those stats apply to the fully fertile population. The odds of getting pregnant month by doing nothing if you have infertility are under 2%. Not zero, but not great. And always an option to keep in mind. If you choose to do nothing, make it a willful choice, not a “woe-is-me-it -just- wasn’t -meant-to-be” surrender.
- Intrauterine insemination (IUI) with or without Oral Medications
IUI, or intrauterine insemination, requires at least one normal fallopian tube and a not-too-bad semen analysis. Letrozole or clomiphene citrate, if indicated, is often the oral medication used with IUI. Pregnancy rates are in the range of 5-15% per cycle, depending on your age and diagnosis. Some couples will try IUI several times before moving on to in vitro fertilization (IVF).
- In Vitro Fertilization (IVF)
IVF is available even if both fallopian tubes are blocked, tied, non-functional or surgically absent. IVF is also an option for those with moderate to severe endometriosis and with severe compromise in semen analysis. It requires at least one functional ovary, at least a few sperm, and a healthy uterus. Variations under the umbrella of IVF may have success rates of over 70% in one cycle, but success is very dependent on female age and diagnosis. I sometimes refer to IVF as flying instead of driving to your destination. Or as a time machine. If your ovaries are able to respond well to fertility medication, then doing one IVF cycle may be thought of as the equivalent of doing 10+ cycles of oral medication with IUI. IVF can be a better choice than IUI with oral medications if time is of the essence. Downside: IVF is costly. But so are tears and time.
- Third Party (Donor Egg, Donor Sperm, Host Uterus)
Third party reproduction is an option when these are absent or compromised in function. Sometimes, we use all three treatments at the same time. While third party reproduction is not first on the list for most individuals, you are almost certain to have a family if you are able to open your heart and mind to these options. What is more important to you? Using your own eggs and sperm with a lower pregnancy rate? Achieving the highest chance of success in the least amount of time? When you are swinging your child on the swing set or enjoying a holiday feast together as a family, will the journey be more important than the destination? These are personal questions.
Adoption should always be considered on the menu. Each choice has advantages and disadvantages. Keep in mind that adoption can be the costliest of all the other options, including IVF. Adoption does not have a 100% success and may entail scrutiny of your suitability to become a parent, which is hard for some.
STEP 3: Expect the unexpected
There is no guarantee of 100% success, zero risk, or zero cost. Things can and will often go wrong. There will be detours along the way. Let’s say your heart is set on delivering a baby during the Chinese Year of the Dragon. Or that you must have your egg retrieval on Tuesday because other obligations make Wednesday more challenging. Or your horoscope says November is the best time to conceive. Or you feel you simply must be pregnant before the holidays. Fertility does not always color in the lines. Something will go wrong. I cannot say what will go wrong or when, but something will go wrong. But it will still be okay. Laugh about it, accept it, and move forward. Remember your destination.
STEP 4: Set Limits
How much time do you have? How much money? How much emotional tenacity?
Like setting your budget for your wedding, house, a car or vacation, think about the resources you feel comfortable allotting to the goal of having a baby to help you choose the path best for you. You know you better than any doctor, friend, or book knows you.
Infertility, and fertility treatment, can be all consuming. Should we go on vacation? I might be ovulating that week! Should we buy a house? We need to wait to see how many bedrooms we need! Of course, you will need to talk about and think about fertility. When you must worry and talk and cry and discuss fertility, set a time frame. I suggest one hour a day. You have one hour a day to think about, talk about, cry about fertility. Wall off this time like your body walls off an abscess to prevent infection taking over the entire body. The other 23 hours do something else. Otherwise, infertility can fester, grow, and consume your life. Do not let it.
STEP 5: Have Fun!
Wear your best lingerie just for yourself. Spray on some cologne. Glide on your favorite lip balm. Giggle. Cuddle. Be sweet to each other. Be kind. Be a good roommate. Get some fresh air, exercise, and keep your spiritual life strong. Keep family, friends, or acquaintances in your social arena (you can decide whether you share your infertility journey with them or keep it to yourself). Keep a hobby. Let the science of medications, schedules and treatments go at times, and just be together for the sheer pleasure of it, without the goal of pregnancy looming over every interaction.
No matter how things turn out, picture yourself at age 80. Do you have a family? Or are you child free? Even if it did not turn out as you had hoped, do you feel good about the information you received and the choices that you made? If so, I predict you will find happiness, contentment, and peace.
Written by Celeste Brabec, M.D.